The diagnostic performance of routinely acquired and reported computed tomography imaging in patients presenting with suspected pleural malignancy

Objectives: Contrast-enhanced computed tomography (CT) provides essential cross-sectional imaging data in patients with suspected pleural malignancy (PM). The performance of CT in routine practice may be lower than in previously reported research. We assessed this relative to ‘real-life’ factors including use of early arterial-phase contrast enhancement (by CT pulmonary angiography (CTPA)) and non-specialist radiology reporting. Materials and methods: Routinely acquired and reported CT scans in patients recruited to the DIAPHRAGM study (a prospective, multi-centre observational study of mesothelioma biomarkers) between January 2014 and April 2016 were retrospectively reviewed. CT reports were classified as malignant if they included specific terms e.g. “suspicious of malignancy”, “stage M1a” and benign if others were used e.g. “indeterminate”, “no cause identified”. All patients followed a standard diagnostic algorithm. The diagnostic performance of CT (overall and based on the above factors) was assessed using 2 × 2 Contingency Tables. Results: 30/345 (9%) eligible patients were excluded (non-contrast (n = 13) or non-contiguous CT (n = 4), incomplete follow-up (n = 13)). 195/315 (62%) patients studied had PM; 90% were cyto-histologically confirmed. 172/315 (55%) presented as an acute admission, of whom 31/172 (18%) had CTPA. Overall, CT sensitivity was 58% (95% CI 51–65%); specificity was 80% (95% CI 72–87%). Sensitivity of CTPA (performed in 31/315 (10%)) was lower (27% (95% CI 9–53%)) than venous-phase CT (61% (95% CI 53–68%) p = 0.0056). Sensitivity of specialist thoracic radiologist reporting was higher (68% (95% CI 55–79%)) than non-specialist reporting (53% (95% CI 44–62%) p = 0.0488). Specificity was not significantly different. Conclusion: The diagnostic performance of CT in routine clinical practice is insufficient to exclude or confirm PM. A benign CT report should not dissuade pleural sampling where the presence of primary or secondary pleural malignancy would alter management. Sensitivity is lower with non-thoracic radiology reporting and particularly low using CTPA

Terrible Silence, Eternal Silence A Consideration of Dinah’s Voicelessness in the Text and Interpretive Traditions of Genesis 34

In this thesis, the author takes a journey through both biblical and contemporary patriarchal cultures, contemplating the commonality of rape survivors’ experiences across space and time, and, in particular, evaluating the insidious and pervasive influences of patriarchy, which have long served to deny these women a voice with which to relate their narrative of suffering. Consideration is given to some of the common contemporary cultural attitudes and misperceptions regarding sexual violence, commonly known as ‘rape myths’, which appear to be rooted within the deeply entrenched gender stereotypes of patriarchal cultures the world over, and which survivors of sexual violence regard as lying at the very heart of their own voicelessness. The author examines the means by which these rape myths silence victims of sexual violence, then, using these myths as a hermeneutical tool, evaluates whether they are likewise given voice within both the text and interpretive traditions of Genesis 34, a biblical narrative recounting the rape of Jacob’s daughter Dinah. When these myths do appear to be represented within this narrative, consideration is then given to the impact that they may likewise have had upon Dinah’s own experience of her violation and thus, upon her ability to share her story. Moreover, the author evaluates the representations of Dinah in her interpretive afterlife, assessing the ways in which biblical interpreters may or may not appeal to these same myths in order both to attend to her silence and to make sense of her experience. This thesis therefore has two primary aims. Firstly, there is an attempt to paint a picture of the world in which Dinah experienced her sexual assault, by casting light upon the attitudes and ideologies that she would have faced from others within her own community. In addition, consideration is also given to the narrative world, which Dinah continues to occupy in the minds of those who read her story, by looking at the responses she has received and continues to receive from this interpretive community. This thesis therefore attempts to provide a deeper insight into Dinah’s own experience of sexual violence, in order that contemporary readers can better comprehend the meaningfulness and complexity of her silence and grant to it a rich and new meaning

Bringing the Apostle Down to Earth: Emily Dickinson Wrestles with Paul

While Emily Dickinson included many allusions to the biblical texts in her writing, this article focuses on her engagement with one particular biblical writer—the apostle Paul. Dickinson makes a number of references to Paul in her letters and poetry, often in ways that thoroughly unbalance what she considered to be his spiritual and heaven-centred gaze, thrusting it earthwards to bring new and unexpected meaning to matters such as friendship, love, death, suffering, and desire. Through taking a closer look at her writings in which she engages with the apostle, I consider Dickinson’s obvious desire to engage with Paul’s writings and her regular rejection of certain features of Pauline theology in favour of her own earth-centred spirituality. In particular, I explore the ways in which Dickinson’s faith stands at times uneasily alongside that of Paul, in her focus on the dreaded uncertainty of life after death and her unshakeable delight for a world in which both pain and paradise could be encountered

Church Responses to Gender-Based Violence Against Women in Samoa

This is a research report from a New Zealand Institute for Pacific Research Project (August 2017-December 2018), which was conducted as a partnership between Piula Theological College, National University of Samoa, University of Auckland, and University of Otago. Abstract: Church membership in Samoa is exceptionally high, and the moral authority and community leadership of churches in society is widely recognised. The churches in Samoa therefore have enormous potential capacity to contribute proactively to social well-being. In recent years the Samoan government, the Ministry of Women, Community and Social Development, and the National Human Rights Institute have identified the importance of prevention initiatives on violence against women (VAW). The Samoan Government Second Progress Report 2010 has highlighted the need to address violence against women, and identified the contribution that churches might make towards this: The churches should be heavily in-volved in addressing violence against women. It is proposed that a special taskforce be established with all the relevant authorities to adequately analyse and determine strategic in-terventions at all levels that would address violence against women effect-tively. The involvement of key NGOs such as Samoa Victim Support as well as the National Council of Churches would play a key role in consolidating appropriate interventions that would reduce violence against women (Samoan Govt. 2010: 10). International experience suggests that biblical texts can promote a significant difference within churches to attitudes and actions on VAW prevention. A biblical and faith-based approach is well-placed to promote social change in Samoa. Work with biblical texts is critical for two reasons. First it addresses the temptation for churches to dismiss VAW prevention as a purely secular issue which is of little concern to the churches. Second, it offers generative resources to critique ways in which churches can be part of the problem, and also support discussion of ways in which churches might take leadership as part of the solution. There are some biblical verses that are widely used to justify or excuse violence against women. However, at the same time that the selective misuse of biblical texts contributes to the problem, there is also recognition that these interpretations should be questioned and challenged. A positive biblical message promoted by the churches can, and should, be offered as an effective response to the misuse of biblical texts. Texts that affirm the dignity and sacred value of all people, as created in the image of God, and highlight the destructive consequences that violence creates for individual, families and communities deserve particular attention. This report is in three main sections. The first section case-studies two group bible studies developed and piloted during the project to promote a deeper discussion on VAW. The bible studies are part of a larger bible study resource, which will be available in both English and Samoan, for work in this area. The second section offers a background briefing on VAW in Samoa with particular attention to the challenges it raises for churches. The third section, emerging from the project conference in Auckland on 11 June 2018, discusses the creative approach adopted by Mercy Ah Siu-Maliko in the research

Early Contrast Enhancement: a novel Magnetic Resonance Imaging biomarker of pleural malignancy

Introduction: Pleural Malignancy (PM) is often occult on subjective radiological assessment. We sought to define a novel, semi-objective Magnetic Resonance Imaging (MRI) biomarker of PM, targeted to increased tumour microvessel density (MVD) and applicable to minimal pleural thickening. Materials and methods: 60 consecutive patients with suspected PM underwent contrast-enhanced 3-T MRI then pleural biopsy. In 58/60, parietal pleura signal intensity (SI) was measured in multiple regions of interest (ROI) at multiple time-points, generating ROI SI/time curves and Mean SI gradient (MSIG: SI increment/time). The diagnostic performance of Early Contrast Enhancement (ECE; which was defined as a SI peak in at least one ROI at or before 4.5 min) was compared with subjective MRI and Computed Tomography (CT) morphology results. MSIG was correlated against tumour MVD (based on Factor VIII immunostain) in 31 patients with Mesothelioma. Results: 71% (41/58) patients had PM. Pleural thickening was <10 mm in 49/58 (84%). ECE sensitivity was 83% (95% CI 61–94%), specificity 83% (95% CI 68–91%), positive predictive value 68% (95% CI 47–84%), negative predictive value 92% (78–97%). ECE performance was similar or superior to subjective CT and MRI. MSIG correlated with MVD (r = 0.4258, p = .02). Discussion: ECE is a semi-objective, perfusion-based biomarker of PM, measurable in minimal pleural thickening. Further studies are warranted

Accompanying Survivors of Sexual Harm: A Toolkit for Churches

Accompanying Survivors of Sexual Harm is a trauma-informed resource that offers education and support of Christian clergy and lay leaders as they respond to sexual harm in their communities. It lays out plans for workshop-based sessions, which aim to educate clergy and lay leaders about • Understanding the nature of sexual harm and its prevalence in New Zealand society • Being alert to and responding in a pastorally sensitive manner to people within their community who have experienced/are experiencing sexual harm • Identifying and articulating some of the scriptural and theological foundations that work to justify/legitimise/enable sexual harm while silencing the voices of victims/survivors • Identifying and articulating some of the scriptural and theological foundations that work to challenge and resist sexual harm • Exploring how their church might work to create a safe space for victims/survivors of sexual harm. The toolkit will be of value to anyone in a church leadership position, including those training for Christian ministry and those who have extensive ministry/leadership experience. It is intentionally ecumenical in nature and does not require knowledge of any one denominational tradition. While some of the content relates specifically to the context of Aotearoa New Zealand, most of the material can be adapted and used further afield. There is space offered throughout the sessions for participants to discuss how issues pertaining to sexual harm relate to their own communities. Participants also have opportunities to consider how their own cultures, contexts, traditions, and languages will help shape their role of accompanying victims and survivors. The toolkit is free for anyone to download and use. If you have any queries about the use of the toolkit, please contact us at [email protected]. We hope this resource is a useful and meaningful tool for all those who accompany victims and survivors on their journey

A prospective cohort study comparing the reactogenicity of trivalent influenza vaccine in pregnant and non-pregnant women

Background: Influenza vaccination during pregnancy can prevent serious illness in expectant mothers and provide protection to newborns; however, historically uptake has been limited due to a number of factors, including safety concerns. Symptomatic complaints are common during pregnancy and may be mistakenly associated with reactions to trivalent influenza vaccine (TIV). To investigate this, we compared post-vaccination events self-reported by pregnant women to events reported by non-pregnant women receiving TIV. Methods: A prospective cohort of 1,086 pregnant women and 314 non-pregnant female healthcare workers (HCWs) who received TIV between March-May 2014 were followed-up seven days post-vaccination to assess local and systemic adverse events following immunisation (AEFIs). Women were surveyed by text message regarding perceived reactions to TIV. Those reporting an AEFI completed an interview by telephone or mobile phone to ascertain details. Logistic regression models adjusting for age and residence were used to compare reactions reported by pregnant women and non-pregnant HCWs. Results: Similar proportions of pregnant women and non-pregnant, female HCWs reported ≥1 reaction following vaccination with TIV (13.0% and 17.3%, respectively; OR = 1.2 [95% CI: 0.8-1.8]). Non-pregnant, female HCWs were more likely to report fever or headache compared to pregnant women (OR: 4.6 [95% CI 2.1-10.3] and OR: 2.2 [95% CI 1.0-4.6], respectively). No other significant differences in reported symptoms were observed. No serious vaccine-associated adverse events were reported, and less than 2% of each group sought medical advice for a reaction. Conclusions: We found no evidence suggesting pregnant women are more likely to report adverse events following influenza vaccination when compared to non-pregnant female HCWs of similar age, and in some cases, pregnant women reported significantly fewer adverse events. These results further support the safety of TIV administered in pregnant women

Classification of antineutrophil cytoplasmic autoantibody vasculitides: The role of antineutrophil cytoplasmic autoantibody specificity for myeloperoxidase or proteinase 3 in disease recognition and prognosis

Anti-neutrophil cytoplasmic antibody (ANCA) vasculitis is a complex disease, with much debate about the utility of systems for classification and diagnosis. We compared three currently used classification systems in predicting disease prognosis

Runx1 deficiency protects against adverse cardiac remodeling following myocardial infarction

Background: Myocardial infarction (MI) is a leading cause of heart failure and death worldwide. Preservation of contractile function and protection against adverse changes in ventricular architecture (cardiac remodeling) are key factors to limiting progression of this condition to heart failure. Consequently, new therapeutic targets are urgently required to achieve this aim. Expression of the Runx1 transcription factor is increased in adult cardiomyocytes after MI; however, the functional role of Runx1 in the heart is unknown. Methods: To address this question, we have generated a novel tamoxifen-inducible cardiomyocyte-specific Runx1-deficient mouse. Mice were subjected to MI by means of coronary artery ligation. Cardiac remodeling and contractile function were assessed extensively at the whole-heart, cardiomyocyte, and molecular levels. Results: Runx1-deficient mice were protected against adverse cardiac remodeling after MI, maintaining ventricular wall thickness and contractile function. Furthermore, these mice lacked eccentric hypertrophy, and their cardiomyocytes exhibited markedly improved calcium handling. At the mechanistic level, these effects were achieved through increased phosphorylation of phospholamban by protein kinase A and relief of sarco/endoplasmic reticulum Ca2+-ATPase inhibition. Enhanced sarco/endoplasmic reticulum Ca2+-ATPase activity in Runx1-deficient mice increased sarcoplasmic reticulum calcium content and sarcoplasmic reticulum–mediated calcium release, preserving cardiomyocyte contraction after MI. Conclusions: Our data identified Runx1 as a novel therapeutic target with translational potential to counteract the effects of adverse cardiac remodeling, thereby improving survival and quality of life among patients with MI

Diagnostic and Prognostic Biomarkers in the Rational Assessment of Mesothelioma (DIAPHRAGM) study:Protocol of a prospective, multicentre, observational study

Introduction: Malignant pleural mesothelioma (MPM) is an asbestos-related cancer, which is difficult to diagnose. Thoracoscopy is frequently required but is not widely available. An accurate, non-invasive diagnostic biomarker would allow early specialist referral, limit diagnostic delays and maximise clinical trial access. Current markers offer insufficient sensitivity and are not routinely used. The SOMAmer proteomic classifier and fibulin-3 have recently demonstrated sensitivity and specificity exceeding 90% in retrospective studies. DIAPHRAGM (Diagnostic and Prognostic Biomarkers in the Rational Assessment of Mesothelioma) is a suitably powered, multicentre, prospective observational study designed to determine whether these markers provide clinically useful diagnostic and prognostic information. Methods and analysis: Serum and plasma (for SOMAscan and fibulin-3, respectively) will be collected at presentation, prior to pleural biopsy/pleurodesis, from 83 to 120 patients with MPM, at least 480 patients with non-MPM pleural disease and 109 asbestos-exposed controls. Final numbers of MPM/non-MPM cases will depend on the incidence of MPM in the study population (estimated at 13–20%). Identical sampling and storage protocols will be used in 22 recruiting centres and histological confirmation sought in all cases. Markers will be measured using the SOMAscan proteomic assay (SomaLogic) and a commercially available fibulin-3 ELISA (USCN Life Science). The SE in the estimated sensitivity and specificity will be <5% for each marker and their performance will be compared with serum mesothelin. Blood levels will be compared with paired pleural fluid levels and MPM tumour volume (using MRI) in a nested substudy. The prognostic value of each marker will be assessed and a large bioresource created. Ethics and dissemination: The study has been approved by the West of Scotland Research Ethics Committee (Ref: 13/WS/0240). A Trial Management Group meets on a monthly basis. Results will be published in peer-reviewed journals, presented at international meetings and disseminated to patient groups. Trial registration number: ISRCTN10079972, Pre-results